Surgical Complications of PD Insertion in Children

Abstract

Purpose: The incidence of complications related to PD catheters is reported to be high. We reviewed our experience on PD catheter-related complications. Methods: Medical records of patients who underwent PD catheter insertion during the period between January 2001 and October 2007 were retrospectively reviewed. Results: Forty-six PD catheter insertions were performed in 41 patients and 17 surgical complications were encountered in 12 patients. The median age of the patients was 110 months (range: 2-210 months). The complications included mechanical obstruction (n=9), exit-site infection (n=3), tunnel infection (n=3), peritonitis (n=1), and pleural effusion (n=1). Mechanical obstruction occurred early in the postoperative period with a median interval of 8 days (range: 0-22 days) and was managed by omentectomy (n=5 mostly laparoscopic), catheter replacement (n=2) or readjustment of catheter tip position (n=2). Infectious complications, including exit-site infection, tunnel infection, and peritonitis, occurred later with a median interval of 265 days (range: 126-701 days). This complication was frequently seen in younger patients with a median age of 14 months (range: 2-200) and was managed by reinsertion (n=3), removal (n=2), or a cuff-shaving procedure (n=2). Conclusions: PD catheter-related complications occurred in as many as 29.3% of patients. Exit-site infection was a late complication of younger children, whereas mechanical obstruction occurred early in the postoperative period. Prophylactic omentectomy may be a reasonable means of preventing the latter complication which was associated with omental wrapping.